Provider Demographics
NPI:1952118218
Name:GISELA RODRIGUEZ LAWSON LLC
Entity type:Organization
Organization Name:GISELA RODRIGUEZ LAWSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:GISELA
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:269-779-3701
Mailing Address - Street 1:1930 W MILHAM AVE STE C
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49024-2228
Mailing Address - Country:US
Mailing Address - Phone:269-779-3701
Mailing Address - Fax:
Practice Address - Street 1:1930 W MILHAM AVE STE C
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49024-2228
Practice Address - Country:US
Practice Address - Phone:269-389-0382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty